In Extremis: The Stark Reality of Life and Death in the ICU

The first time intensive care unit physician Jessica Zitter encountered the “family support team” — a precursor to the palliative care services now routinely found in hospitals — it didn’t go well. Zitter felt threatened. She thought, “Who are these people getting in the middle of my relationship with my patients and telling me I’m not doing it well or not asking enough questions?”

Like many doctors early in their careers, Zitter was convinced her role was to save patients “from the jaws of death.” Over the years, however, she came to realize she was often causing more suffering, particularly for those who were dying or frail. But that was the paradigm in which she had been trained. “The way I had been taught,” she said, “was when this organ starts to fail, insert this catheter. And when that cardiac function isn’t working, use this medication. And when the person stops being able to breathe, insert a breathing tube.”

Steven Birenbaum is a senior communications officer at CHCF, where he promotes the foundation’s reports and initiatives to key audiences and manages a portfolio of public media grants.

Prior to joining CHCF in 2005, Steven was executive writer at Blue Shield of California, where he wrote speeches, presentations, op-eds, and byline articles for the CEO and senior executives, helped produce the company’s annual report and its monthly internal communications newsletter. Previously, he was a senior writer and account manager at Chandler Chicco Agency, a public relations firm, where he provided product promotion and issues management support to leading pharmaceutical companies. As a writer, his work has been published in the New York Times, Newsday, and KQED, among other news outlets. Steven received a bachelor’s degree in political science and history from the University of Wisconsin-Madison and a master’s of public affairs from the LBJ School of Public Affairs at the University of Texas, Austin.